Efficacy and prognostic factors of imatinib plus CALLG2008 protocol in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia

doi:10.1007/s11684-017-0506-y

Front. Med.

2017, Vol. 11

Issue (2) : 229-238 https://doi.org/10.1007/s11684-017-0506-y

RESEARCH ARTICLE

Efficacy and prognostic factors of imatinib plus CALLG2008 protocol in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia

Yinjun Lou^1,², Yafang Ma¹, Chenyin Li¹, Sansan Suo¹, Hongyan Tong¹, Wenbin Qian¹, Wenyuan Mai¹, Haitao Meng¹, Wenjuan Yu¹, Liping Mao¹, Juyin Wei¹, Weilei Xu¹, Jie Jin^1,²(

)

¹. Institute of Hematology, Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
². Key Laboratory of Hematopoietic Malignancies, Zhejiang Province, Hangzhou 310003, China

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Abstract

A CALLG2008 protocol was developed by the Chinese Acute Lymphoblastic Leukemia Cooperative Group for adult acute lymphoblastic leukemia (ALL). We retrospectively analyzed 153 newly diagnosed adult patients with Philadelphia chromosome (Ph)-positive ALL enrolled into imatinib (400 mg/d) plus CALLG2008 regimen between 2009 and 2015. The median age was 40 years (range, 18–68 years), with 81 (52.3%) males. The overall hematologic complete remission (CR) rate was 96.7% after induction. With a median follow-up of 24.2 months, the estimated 3-year overall survival (OS) and event-free survival (EFS) rates were 49.5% (95% confidence interval (CI): 38.5%–59.5%) and 49.2% (95% CI: 38.3%–59.2%), respectively. Fifty-eight (36 with haploidentical donor) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first CR. Among the patients in CR1 after induction, both the 3-year OS and EFS were significantly better in the allo-HSCT group than in the without allo-HSCT group (73.2%, 95% CI: 58.3%–83.5% vs. 22.2%, 95% CI: 8.7%–39.6% and 66.5%, 95% CI: 50.7%–78.2% vs. 16.1%, 95% CI: 5.1%–32.7%, respectively). Multivariate analysis showed that allo-HSCT and achievement of major molecular response were associated with favorable OS or EFS independently. Interestingly, in the allo-HSCT cohort, the donor type (haploidentical versus matched donors) had no significant impact on EFS or OS. All these results suggested that imatinib plus CALLG2008 was an effective protocol for Ph-positive ALL. Haploidentical donors can also be a reasonable alternative expedient donor pool.

Keywords Philadelphia chromosome acute lymphoblastic leukemia imatinib CALLG2008

Corresponding Author(s): Jie Jin

Just Accepted Date: 20 January 2017 Online First Date: 24 March 2017 Issue Date: 01 June 2017

Cite this article:

Yinjun Lou,Yafang Ma,Chenyin Li, et al. Efficacy and prognostic factors of imatinib plus CALLG2008 protocol in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia[J]. Front. Med., 2017, 11(2): 229-238.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0506-y
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I2/229

Tab.1 Modified CALLG2008 chemotherapy protocol for Philadelphia chromosome-positive acute lymphoblastic leukemia

Tab.2 Comparison of the characteristics patients with allo-HSCT or without HSCT

Fig.1 Kaplan–Meier curves for overall survival (A) and event-free survival (B) in all Ph-positive ALL treated with imatinib plus CALLG2008 frontline therapy.

Fig.2 Comparing Kaplan–Meier curves in allo-HSCT group (n = 58) with chemotherapy group (n = 90) according to the post-remission therapy. (A) overall survival; (B) event-free survival.

Fig.3 Comparing Kaplan-Meier curves in allo-HSCT group with chemotherapy group according to the post-remission therapy. (A) Overall survival (≤39 years); (B) overall survival (>39 years); (C) event-free survival (≤39 years); (D) event-free survival (>39 years).

Tab.3 Univariate and multivariate analysis of event-free survival and overall survival in the entire patients

Tab.4 Univariate and multivariate analysis of event-free survival and overall survival in the patients receiving allo-HSCT group

Tab.5 Univariate and multivariate analysis of event-free survival and overall survival in the patients without allo-HSCT group

Tab.6 Comparing current treatment strategies for patients with adult Philadelphia chromosome-positive acute lymphoblastic leukemia

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